Esophageal Cancer

Esophageal cancer, also spelled oesophageal cancer, develops when cells in the lining of the oesophagus grow out of control. The oesophagus is the long, muscular tube that connects the throat to the stomach and moves food down by gentle, wave-like contractions.

There are two main types. Adenocarcinoma usually starts in gland cells in the lower part of the oesophagus, near the stomach, and is often linked to long-term acid reflux. Squamous cell carcinoma starts in the flat cells that line the upper and middle parts of the oesophagus and is more closely linked to smoking and alcohol.

Knowing the type and location of the cancer helps the medical team plan treatment, because the two types can behave differently and may respond to different approaches.

The most common symptom is difficulty swallowing (dysphagia). At first it may feel like food is sticking in the throat or chest, and over time swallowing solids and then liquids can become harder. Some people also feel pain or discomfort when swallowing.

Other symptoms can include unintentional weight loss, persistent heartburn or indigestion, bringing food back up, a persistent cough or hoarse voice, pain in the chest or upper back, and feeling tired. Vomiting blood or passing dark stools can occur if the cancer bleeds.

Many of these symptoms have causes other than cancer, but ongoing trouble swallowing should never be ignored. It is important to see a doctor promptly so the cause can be found and treated.

Several factors increase the risk. Smoking and drinking a lot of alcohol are major risk factors, especially for squamous cell carcinoma, and the risk is higher in people who do both.

Long-term acid reflux (gastro-oesophageal reflux disease, or GORD) is an important risk factor for adenocarcinoma. Persistent reflux can lead to a condition called Barrett's oesophagus, in which the cells lining the lower oesophagus change and carry a higher risk of developing into cancer over time.

Other factors include older age, being male, being very overweight, and a diet low in fruit and vegetables. Having a risk factor does not mean a person will develop the cancer, and not smoking, limiting alcohol, keeping to a healthy weight and managing reflux can all help reduce the risk.

The main test is an endoscopy (gastroscopy), in which a thin tube with a camera is passed down the throat to look at the lining of the oesophagus. If an abnormal area is found, the doctor takes a biopsy so the tissue can be examined under a microscope.

If cancer is confirmed, further tests show how far it has spread. These can include CT scans, a PET-CT scan, and an endoscopic ultrasound, which uses sound waves from inside the oesophagus to see how deep the tumour goes and whether nearby lymph nodes are affected.

Putting this information together is called staging. It helps the team decide whether the aim of treatment is to cure the cancer or to control it and relieve symptoms, and which treatments are most likely to help.

Treatment depends on the type, stage and position of the cancer and on a person's general health. Plans are made by a team of specialists and often combine more than one treatment.

Surgery to remove part or all of the oesophagus (oesophagectomy) may be used when the cancer has not spread too far. Chemotherapy and radiotherapy are frequently given before surgery to shrink the tumour, or together as the main treatment when surgery is not suitable. Some cancers also respond to targeted therapy or immunotherapy chosen on the basis of laboratory tests.

When swallowing is badly affected, treatments can help keep the oesophagus open and make eating easier. These include placing a small tube called a stent to hold the oesophagus open, and other procedures to relieve a blockage.

Because esophageal cancer and its treatment affect swallowing, keeping up good nutrition is an important part of care. A dietitian can suggest softer or higher-calorie foods and, if needed, nutritional drinks.

Some people need extra support to take in enough food, such as feeding through a tube for a period of time. The team will explain the options and help find the approach that keeps a person as well-nourished and comfortable as possible.

Not all cases can be prevented, but the risk can be lowered by not smoking, limiting alcohol, keeping to a healthy weight, and eating plenty of fruit and vegetables. Getting persistent reflux assessed and treated is also sensible, as long-standing reflux is linked to a higher risk.

People with Barrett's oesophagus may be offered regular monitoring so that any early changes can be found and treated before they become cancer.

The outlook depends largely on the stage when the cancer is found. Because difficulty swallowing can appear gradually, getting it checked early is one of the most important steps. The medical team can give the most accurate picture for an individual situation.